Provider Demographics
NPI:1053629048
Name:POPPE, JAMES ALLEN
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ALLEN
Last Name:POPPE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 YELLOW CREEK RD
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-5227
Mailing Address - Country:US
Mailing Address - Phone:307-789-0535
Mailing Address - Fax:307-789-9550
Practice Address - Street 1:70 YELLOW CREEK RD
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-5227
Practice Address - Country:US
Practice Address - Phone:307-789-0535
Practice Address - Fax:307-789-9550
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1842183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist